Evaluation Of Placental Function In Fetal Growth Restriction And Hypertensive Disorder Complicating Pregnancy By Three-dimensional Power Doppler Ultrasound

Objective:The structure of villous blood vessels in the placenta of normal pregnancy during late pregnancy(28-40 weeks)was analyzed by three-dimensional power Doppler ultrasound(3D-PDU);and the 3D-PDU placental blood vessel index VI,FI,VFI values were collected and plotted with the gestational age(GA)trends and define its reference range;further analysis of the repeatability of VI,FI,VFI.To evaluate the applicability of 3D-PDU as a screening tool for blood vessel density and blood perfusion in placenta during pregnancy.Materials and Methods:A total of 297 pregnant women with normal pregnancy who had a card and delivered in the obstetrics department of the First Affiliated Hospital of Chengdu Medical College from January 2019 to December 2019 were collected.The gestational week range was 28-40 weeks.All patients were examined with a GE Voluson E8 color Doppler ultrasound system 3.5–6 MHz volume probe.The 3D-PDU mode was used to scan the placenta.The 4D-View software was used to place the placenta between the basement plate and the chorionic plate"Biopsy"revealed 3 fixed-volume spherical sampling ranges,with the central sampling point located at the umbilical cord-placenta entrance,and two other sampling points equidistant from the center.The VOCAL~TMM technology is used to describe at 15°rotation angle in multiple planes,and the VI,FI,and VFI values in the sampled sphere are calculated.The average of 3 measurements is used for the final statistical analysis.Use SPSS 21.0 software to process the data,calculate the linear regression coefficients of VI,FI,VFI and gestational week,and define the predicted value(PV)and±SD value of vascular index at each gestational week according to the most approximate index;Internal Correlation Coefficient(ICC)to evaluate,ICC>0.75 means good reliability.Results:During normal late pregnancy,3D-PDU shows 100%of primary and secondary villous blood vessels in the placenta,92.3%of third villous blood vessels,and 76.9%of the four villous blood vessels and distal branches;VI,FI,VFI is linearly positively correlated with GA,where VI(r=0.341,P=0.0001),VFI(r=0.292,P=0.0001)and GA are significantly linearly positively correlated with,FI(r=0.142,P=0.041)and GA showed a weak linear correlation.At the same time,the PV and±SD values of placenta VI,FI,VFI corresponding to each gestational week in normal pregnancy and late pregnancy were calculated.The ICC of all vascular indexes was greater than 0.85,and the consistency within the observer was better.Conclusion:3D-PDU can perform visual,dynamic,and multi-angle real visualization of the villous blood vessels in the placenta,and there is a high degree of agreement with the morphology of the placental vasculature;VI,FI,and VFI in normal pregnancy during late pregnancy show an increase with GA it shows an increasing trend,indicating that the villous blood vessel density and blood flow perfusion in the placenta increase with the progress of pregnancy;the PV and±SD values of the normal pregnancy placenta VI,FI,VFI have certain guiding significance for the use of this technology in the hospital in the future.The application of 3D-PDU can provide an important reference value for the qualitative and quantitative assessment of the shape,density and blood perfusion of villous blood vessels in the placenta.Objective:Using three-dimensional power Doppler(3D-PDU)to describe the structure of villous blood vessels in placenta of hypertensive disorder complicating pregnancy(HDCP)and fetal growth restriction(FGR);Analysis of the diagnostic and differential diagnostic value of 3D-PDU placental vascular index VI,FI,and VFI for HDCP and FGR,To investigate whether the use of 3D-PDU in late pregnancy can be an important ultrasound monitoring method for managing high-risk pregnant women and fetuses.Materials and Methods:A prospective study was conducted to collect 412 pregnant women in late pregnancy(28-40 weeks)who delivered a full card in the obstetrics department of the First Affiliated Hospital of Chengdu Medical College from January 2019 to December2019.At the same time,all pregnant women's blood pressure,age,parity,delivery methods,delivery weeks and newborn Apgar scores,cord blood PH value,actual birth weight,etc.were recorded.All patients were examined with a GE Voluson E8 convex array probe(3 to 5MHz)and a volume probe(3.5–6 MHz).A conventional ultrasound scan of the fetus was performed using a convex array probe,and the estimated fetal weight(EFW)by the Hadlock formula,and the actual weight of the fetus after birth was followed up.Scan the placenta with the volume probe on 3D-PDU mode.The 4D-View software was used to place the placenta between the basement plate and the chorionic plate "Biopsy" revealed3 fixed-volume spherical sampling ranges,with the central sampling point located at the umbilical cord-placenta entrance,and two other sampling points equidistant from the center.The VOCALTM technology is used to describe at 15 °rotation angle in multiple planes,and the VI,FI,and VFI values in the sampled sphere are calculated.The average of 3 measurements is used for the final statistical analysis.On the one hand,the 3D-PDU imaging mode was first used to compare and analyze the changes of the villous vascular structure in the placenta of normal pregnancy,FGR,and HDCP.Second,the-SD values of VI,FI,and VFI were calculated to diagnose the sensitivity and specificity of FGR and HDCP,respectively.Discuss the clinical application value of 3D-PDU for FGR and HDCP.On the other hand,first compare the changes and characteristics of VI,FI,and VFI in SGA and FGR,and then compare the changes and characteristics of VI,FI,and VFI in GHT,PE,and eclampsia,comprehensively discuss the differential diagnostic value of vascular index on FGR and HDCP,respectively.SPSS21.0 software was used for data sorting and screening and statistical analysis,measurement data were recorded in the form,Kruskal-Wallis H test was used for each measurement index between groups,and Bonferroni correction was used for comparison between groups.The sensitivity and specificity of each vascular index were measured using ROC curves.The test level was 0.05,and P <0.05 was considered statistically significant.Results:Compared with normal pregnancy,it is found that the number of villous blood vessels in the FGR placenta is reduced,the volume is reduced,the shape is relatively single,and it is impossible to form a vascular network with the uterine-spiral arteries and branches.In the HDCP placenta,the diameter of the villous blood vessels is uneven,the surface is irregular,with nodules and depressions,and the uterine-spiral artery and its branches are not shown.In the fetal group,there was no significant difference between the general information of the patients(maternal age,gestational week and parity at the time of examination)compared with the control group(P> 0.05).The pregnant women of SGA and FGR had early delivery and cesarean section The incidence of childbirth is high(P<0.01),and the fetal weight at birth,umbilical artery PH value and Apgar score are low(P <0.01);Compared with FGR,SGA had higher cesarean delivery rate,lower fetal birth,umbilical artery PH value,and lower Apgar score(P <0.05).Taking the 32-week gestational vascular index-SD as a sample,the sensitivity of EFW,VI,VFI,and FI to predict FGR was calculated by the receiver operating characteristic curve(ROC): 45.6%,66.3%,89.9%,and 81.2%.Specificity is: 51.5%,74.8%,93.4%,88.1%;Compared with the control group,VI,FI,and VFI decreased in FGR and SGA(P <0.05),where FI decreased significantly in FGR(p <0.01),and VI and VFI decreased significantly in SGA(P <0.01).Compared with SGR and FGR,there was no significant difference between VI and VFI(P> 0.05),only FI decreased in FGR(P <0.05).In the pregnant women group,there was no significant difference between the general information of the patients(maternal age,gestational week,parity at the time of examination)compared with the control group(P> 0.05),GHT,PE,and eclampsia pregnant women deliver early and have a high incidence of cesarean section(P <0.01),and their fetal weight at birth,umbilical artery p H,and Apgar score are low(P<0.01);Comparing GHT,PE,and eclampsia,pregnant women's SBP and DBP increased in order according to the severity of the disease,and their fetal weight at birth,umbilical artery PH value,and Apgar score decreased in order(P <0.05);Taking the 32-week gestational vascular index PV as a sample,the sensitivity of DBP,SBP,VI,VFI,and FI to predict HDCP was calculated from the receiver operating characteristic curve(ROC):57.9%,82.2%,84.3%,and 75.6,respectively.%,86.6%,specificity: 69.2%,89.8%,73.8%,71.3%,92.1%;Compared with the control group,VI,FI,and VFI in GHT,PE,and eclampsia decreased in order(P <0.05).Compared with GHT and PE,eclampsia significantly decreased VI,FI,and VFI(P <0.05).Conclusion:Using 3D-PDU imaging in late pregnancy can provide new information for abnormalities of placental vessel density and morphology in FGR and HDCP,Vascular index VI,FI,and VFI have good sensitivity and specificity in the diagnosis of FGR and HDCP,respectively,significant clinical application value for the aforementioned adverse pregnancy.VI,FI,and VFI are not only the best parameters for identifying GHT,PE,and eclampsia,but also have important help in determining the severity of HDCP,And FI may help to distinguish SGA and FGR.3D-PDU in late pregnancy is of great significance for clinical management of high-risk maternal and fetal pregnancy.